This document summarizes a seminar presentation on tobacco cessation. It discusses the large number of tobacco users in India and the health impacts of tobacco use. It outlines regulatory, service-based, and educational approaches to tobacco control and the role of dentists in counseling patients. The 5 A's model for tobacco cessation counseling is described. Nicotine replacement therapies and other pharmacological aids are discussed. The presentation emphasizes the importance of dentists' involvement in tobacco control through counseling, advocacy, and community education efforts.

1. GOOD
MORNING !

2. SEMINAR

3. TOBACCO CESSATION
YASMIN MOIDIN
2008 BATCH
AL AZHAR DENTAL COLLEGE
THODUPUZHA

4. INTRODUCTION

Prevention of oral cancer mainly focuses on
modifying habits associated with the use of
tobacco

India is the largest consumer of tobacco and
third largest producer of tobacco

There are about 250 million tobacco users in
India

In India, at least 800,000 deaths every year
are related to tobacco use, and 700,000
them due to smoking
of

5. 
There are three well-known approaches
 Regulatory
approach
 1975
: Cigarette Act
 1985
: National Cancer Control Program
 2003
:
Cigarettes
Products Act
 2004
: WHO-FCTC
 Service
approach
 screening
and
other
Tobacco

6. 
Educational approach

Role of the dentist
 harmful
effects of tobacco
 counsel
patients
 tobacco-free
 tobacco
 spend
lifestyle
use during pregnancy
more time with patients
 reinforce
messages given to patients

7.  build
their
patient’s
interest
to
discontinue
 promote
oral
health
and
healthy
lifestyles
 speak
with authority in the community
 effective
advocates for tobacco control
in the community

8. Guide to counseling for tobacco
cessation (5 A’s)
ASK about
patient’s habit
• Identify and document tobacco user
status of every patient at every visit
ADVICE of
consequence
of smoking
• In a clear, strong and personalized
manner urge every tobacco user to quit
ASSESS
willingness to
quit
• Is the tobacco user willing to make a quit
attempt at this time ?

9. ASSIST with • For the patient willing to make
a quit attempt, use counseling
cessation
and pharmacotherapy to help
plant
him quit
development
ARRANGE
for follow-up
• Schedule follow-up contact,
preferably within the first week
after the quit date

10. NICOTINE REPLACEMENT
THERAPY

Nicotine replacement therapies (NRT) for
tobacco use cessation are :
 Nicotine
gum
 Nicotine
patch
 Nicotine
inhaler
 Nicotine
nasal spray
 Nicotine
lozenges

11. 
Basic principles for prescribing NRTs
 Medical
 Use
supervision is important
a lower dose for less dependent
tobacco users
 Contraindicated
,
:
lactation,
diseases,
disease,
,
in
cardiovascular
peripheral
endocrine
inflammation
throat,
pregnancy
of
the
oesophagitis,
vascular
disorders
mouth
and
gastric

12. 
Nicotine gum
 use
under medical supervision for a
predefined limited period, e.g. 6 weeks
, after which the patient has to face
withdrawal

13. 
Nicotine withdrawal symptoms

Craving for tobacco

Depressed mood

Insomnia

Irritability

Frustration

Anxiety

Difficulty in concentration

Restlessness

Decreased heart rate

Increased appetite and weight gain

14. 
Antidepressants
 Function
as anti-craving medications
 Available
therapies :
 First-line
therapies

Buproprion SR

Selegeline
 Second-line

Clonidine

nortryptiline
therapies

15. 
Counseling those unwilling to quit
 Relevance
 Risks
of quitting
of continuing tobacco use
 Rewards
of quitting
 Roadblocks
 Repeat
to quitting
these at each visit

16. 
Key counseling concepts

A non judgmental attitude

Caring

Empathy

Listening

Raising awareness

Prompting self-evaluation

Offering support

Asking open-ended questions

Clarifying

17. 
Reflecting feelings

Summarizing

Affirming

Eliciting self-motivational statements

Setting realistic goals

Responding to tricky questions

Tailoring messages to the patients stage
of change

18. ACTION IN THE COMMUNITY
Public education
 Media advocacy


ACTION AT THE STATE AND NATIONAL
LEVELS
Making the profession and dental
facilities tobacco-free
 Advocacy with the state and national
governments


19. CONCLUSION
A majority of cancer deaths worldwide
are due to tobacco. These are easily
avoidable since the factors associated
with the disease have long been
identified.

20. REFERENCES
Essentials
of
Preventive
and
Community Dentistry – Fourth Edition
2009
SOBEN PETER
Textbook of Public Health Dentistry –
First Edition 2011 C M MARYA

21. THANK
THANK YOU !
YOU !